Provider Demographics
NPI:1073629317
Name:TSAO, FANNY (LAC)
Entity Type:Individual
Prefix:
First Name:FANNY
Middle Name:
Last Name:TSAO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 HANOVER RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1796
Mailing Address - Country:US
Mailing Address - Phone:626-854-7577
Mailing Address - Fax:
Practice Address - Street 1:1661 HANOVER RD
Practice Address - Street 2:SUITE 217
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1796
Practice Address - Country:US
Practice Address - Phone:626-854-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist